Please fix the highlighted areas below before submitting.

Interest Form﻿

Please utilize this form for the 2018-2019 school year.

For additional enrollment information, please complete and submit the form below. This information will be passed on to a Personalized Learning Teacher (PLT) who will contact you to set up an appointment.

Please do not withdraw your child from their current school until you are actively enrolled in our program.

Parent or Guardian Contact Information:

Name: First and Last*

Please state the city you live in.*

Phone number

Email address:

Student Information:

Name: First and Last*

Grade:*

Age:*

Have you ever been enrolled with us in the past?

Yes

No

Is your child UC bound?

Yes

No

Do you have a specific teacher in mind?

How did you learn about us?

Any additional comments?

Confirmation Email

Confirmation Email

Enter your email address here if you'd like to receive a confirmation upon submitting the form.